Butyric acid (BA) is a natural product. It is supplied to mammals from two main sources: 1) the diet, mainly from dairy fat, and 2) from the bacterial fermentation of unabsorbed carbohydrates in the colon, where it reaches mM concentrations (Cummings, Gut 22:763-779,1982; Leder et al., Cell 5:319-322, 1975).
BA has been known for nearly the last three decades to be a potent differentiating and antiproliferative agent in a wide spectrum of neoplastic cells in vitro (Prasad, Life Sci. 27:1351-1358, 1980). In cancer cells, BA has been reported to induce cellular and biochemical changes, e.g., in cell morphology, enzyme activity, receptor expression and cell-surface antigens (Nordenberg etal., Exp. Cell Res. 162:77-85, 1986; Nordenberg et al., Br. J. Cancer 56:493-497, 1987; and Fishman et al., J. Biol. Chem. 254:4342-4344, 1979).
Although BA or its sodium salt (sodium butyrate, SB) has been the subject of numerous studies, its mode of action is unclear. The most specific effect of butyric acid is inhibition of nuclear deacetylase(s), resulting in hyperacetylation of histones H3 and H4 (Riggs, et al., Nature 263:462-464, 1977). Increased histone acetylation following treatment with BA has been correlated with changes in transcriptional activity and the differentiated state of cells (Thorne et al., Eur. J. Biochem. 193:701-713, 1990). BA also exerts other nuclear actions, including modifications in the extent of phosphorylation (Boffa et al., J. Biol. Chem. 256:9612-9621, 1981) and methylation (Haan et al., Cancer Res. 46:713-716, 1986). Other cellular organelles, e.g., cytoskeleton and membrane composition and function, have been shown to be affected by BA (Bourgeade et al., J. Interferon Res. 1:323-332, 1981). Modulations in the expression of oncogenes and suppressor genes by BA were demonstrated in several cell types. Toscani et al., reported alterations in c-myc, p53 thymidine kinase, c-fos and AP2 in 3T3 fibroblasts (Oncogene Res. 3:223-238, 1988). A decrease in the expression of c-myc and H-ras oncogenes in B16 melanoma and in c-myc in HL60 promyelocytic leukemia was also reported (Prasad et al., Biochem. Cell Biol. 68:1250-1255, 1992: and Rabizadeh et al., FEBS Lett. 328:225-229, 1993).
BA has been reported to induce apoptosis, i.e., programmed cell death. SB has been shown to produce apoptosis in vitro in human colon carcinoma, leukemia and retinoblastoma cell lines (Bhatia et al., Cell Growth Diff. 6:937-944, 1995; Conway et al., Oncol. Res. 7:289-297,1993; Hague et al.; Int. J. Cancer 60:400-406, 1995). Apoptosis is the physiological mechanism for the elimination of cells in a controlled and timely manner. Organisms maintain a delicate balance between cell proliferation and cell death, which when disrupted can tip the balance between cancer, in the case of over accumulation of cells, and degenerative diseases, in the case of premature cell losses. Hence, inhibition of apoptosis can contribute to tumor growth and promote progression of neoplastic conditions.
The promising in vitro antitumor effects of BA and BA salts led to the initiation of clinical trials for the treatment of cancer patients with observed minimal or transient efficacy. [Novogrodsky et al., Cancer 51:9-14, 1983; Rephaeli et al., Intl. J. Oncol. 4:1387-1391,1994; Miller et al., Eur. J. Cancer Clin. Oncol. 23:1283-1287,1987].
Clinical trials have been conducted for the treatment of .beta.-globin disorders (e.g., .beta.-thalassemia and sickle-cell anemia) using BA salts. The BA salts elevated expression of fetal hemoglobin (HbF), normally repressed in adults, and favorably modified the disease symptoms in these patients (Stamatoyannopouos et al., Ann. Rev. Med. 43:497-521, 1992). In this regard, arginine butyrate (AB) has been used in clinical trials with moderate efficacy (Perrine et al., N. Eng. J. Med. 328:81-86, 1993; Sher et al., N. Eng. J. Med. 332:1606-1610, 1995). The reported side effects of AB included hypokalemia, headache, nausea and vomiting in .beta.-thalassemia and sickle-cell anemia patients.
Butyric acid derivatives having antitumor activity and immunomodulatory properties have been reported in U.S. Pat. No. 5,200,553 and by Nudelman et al., 1992, J. Med. Chem. 35:687-694. The most active butyric acid prodrug reported in these references was pivaloyloxymethyl butyrate. None of the compounds disclosed in these references included oxyalkylene butyrate compounds of this invention.
BA and/or its analogues have also been reported to increase the expression of transfected DNA (Carstea et al., 1993, Biophys. Biohem. Res. Comm. 192:649; Cheng et al., 1995, Am. J. Physical 268:L615-L624) and to induce tumor-restricted gene expression by adenovirus vectors (Tang et al., 1994, Cancer Gene Therapy 1:15-20). Tributyrin has been reported to enhance the expression of a reporter gene in primary and immortalized cell lines (Smith et al., 1995, Biotechniques 18:852-835).
Straight short chain fatty acids such as butyric acid are metabolized by .beta.-oxidation that occurs in the mitochondria. Two-carbon fragments are sequentially removed from the carboxyl end of the fatty acid following dehydrogenation, hydration and oxidation to form a .beta.-keto acid, which is then split by thiolysis. Consequently, BA and its salts are normally metabolized rapidly and have very short half-lives in vivo, such that the achievement and maintenance of effective plasma concentrations are problems associated with BA and BA salts, particularly for in vivo uses. BA and BA salts have required large doses to achieve even minimal therapeutic effects. Because of the high dosage, fluid overload and mild alkalosis may occur. Patients receiving BA emanate an unpleasant odor that is socially unacceptable.
Several drugs have been shown to decrease mitochondrial .beta.-oxidation of fatty acids, such as ibuprofen (Freneaux, et al., 1990, J. Pharmacol. Exp. Ther., 255:529-535), aminetepine (Ramain, et al., 1981, Gastroenterol. Clin. Biol., 5:469471; Le Dinh, et al., 1988, J. Pharmacol. Exp. Ther., 247:745-750), tianeptine (Fromenty, et al., 1989, Biochem. Pharmacol., 38:3743-3751), aminodarone (Fromenty, et al., 1990, Biochem. Pharmacol., 255:1377-1384), tetracycline (Zimmerman, et al., 1988, Hepatology, 8:1056-1062), and valproic acid and salicylic acid (Deschamps, et al., 1991, J. Pharmacol. Exp. Ther., 259:894-904).
While BA salts have been shown to increase HbF expression, and appear to hold therapeutic promise with low toxicity in cancer patients, they nevertheless have shown low potency in in vitro assays and clinical trials. There also remains a need to identify compounds as effective or more effective than BA or BA salts as differentiating or anti-proliferating agents for the treatment of cancers. Such compounds need to have higher potency than BA without the problems associated with BA (such as bad odor). Consequently, there remains a need for therapeutic compounds that either deliver BA to cells in a longer acting form or which have similar activity as BA but a longer duration of effectiveness in vivo.
The compounds of this invention address these needs and are more potent than BA or BA salts for treating cancers and other proliferative diseases, for treating gastrointestinal disorders, for wound healing and for treating blood disorders such as thalassemia, sickle cell anemia and other anemias, for modulating an immune response, for enhancing recombinant gene expression, for treating insulin-dependent patients, for treating cystic fibrosis patients, for inhibiting telomerase activity, for detecting cancerous or malignant cells, for treating virus-associated tumors, especially EBV-associated tumors, for modulating gene expression and particularly for augmenting expression of a tumor suppressor gene, for inducing tolerance to an antigen, reducing pain and/or inflammation for treating preventing or amelioraating protozoan infection and for inhibiting histone deactylase in cells. One of the advantages of the compounds of the invention is increased water solubility of the free carboxylic acids compounds of the invention and their salts, and easier administration, especially for intravenous administration.